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What Can Cause Damage to Your Kidneys? The Risks Of Drug Abuse

Last Updated: January 17, 2022

Reviewed by Michael Espelin APRN

Kidneys are the excretory machinery of the body. While the liver is the metabolic center for most drugs, the byproducts are excreted by the kidneys. With this said, liver damage from medication is also possible. So exactly what can cause damage to your kidneys?  Every drug in more than recommended quantity poses some kind of reversible or irreversible threat of damage to the kidneys. Still, there are drugs like tobacco products, alcohol, benzodiazepines, opiates, meth, heroin, inhalants, and many more that can cause frequent damage to the kidneys. Here is an overview of which drugs can cause renal damage and how they exert their effects.

How Do Kidneys Excrete Drugs?

Kidneys are the filters that eliminate the drug from body systems. Most drugs that are water-soluble and their metabolites get excreted in the urine. They get eliminated by the body either by biotransformation in the liver or excretion through the kidney. Non-volatile drugs are circulated in blood in their active form. They get filtered out of glomerular capillaries in the kidney and excreted out in the urine. Furthermore, the renal system also has biotransformation enzymes for drug metabolism to convert them into their more soluble form so that they can be excreted in the urine.

Kidney Damage from Medications

Drugs and medications cause over 20% of acute kidney injuries. With the rise of medicinal sciences, the amount of nephrotoxic drugs has also increased. The incidence rate of acute kidney injury in adults is 22% while the mortality rate is up to 24%. Acute kidney injury is damage to kidneys is a disease that can range from anywhere from mild damage to kidneys to renal failure. It can result from any insult to the kidneys such as serious disease and drug overdose. Furthermore, a drug overdose can cause cardiovascular failure. These happen usually over a short time period, typically within 1-2 days. Transient damage to the kidneys can progress to irreversible renal failure when more than 90-95% of glomeruli are damaged and kidneys cannot perform their function properly.

Symptoms of Renal Failure Include: 

  • Fatigue
  • Nausea
  • Poor appetite
  • Irritability
  • Orbital and pedal edema
  • Pale skin
  • Anemia
  • Muscle cramps
  • Itching

Most of these symptoms are vague and renal function tests have to be done for proper evaluation. More than the recommended doses of even generally safe medications can cause severe damage to kidneys. Once the treatment for renal failure is started, these symptoms will gradually improve. Although kidney failure is an irreversible condition, it is not fatal if treated properly and on time.

A doctor holds a picture of kidneys in his hands.

What Medications Can Damage Your Kidneys

Many prescription medicines and over counter medications can cause acute and chronic renal damage. Overdose or improper dosage of medicines can lead to acute renal injury or acute renal failure. So what medications can damage your kidneys?

Here Is The Information About Some Common Medicines Responsible for Renal Failure:

And many other miscellaneous drugs. These drugs cause damage to kidneys by varying mechanisms. They work by either altering renal hemodynamic causing injury, glomerular toxicity causing reversible or irreversible damage from drug abuse, tubular cells toxicity, and inflammation. These effects of substance abuse are quite dangerous and require medical assistance.

Illegal Drugs That Cause Kidney Failure

Drugs of abuse are mainly nephrotoxic and cause serious toxic effects even on the brain. So how does addiction affect the brain? These toxic effects include hyperthermia, hypotonic hyponatremia due to its arginine vasopressin secretagogue–like effects, rhabdomyolysis, and cardiovascular collapse.

Drugs That Cause Kidney Failure Are:

  • Nicotine present in tobacco and its metabolites can cause direct tubular injury and tubular toxicity which can result in damage to kidneys.
  • Cocaine
  • Amphetamines
  • Ketamine
  • Opioids such as Morphine and Heroin

What damages kidneys when one takes these drugs? These drugs cause toxicity by different mechanisms.  Illegal drugs that can cause kidney failure like сocaine can increase blood pressure causing stress to the kidney which can progress to kidney failure. The connection between cocaine and erectile dysfunction is also well known to the medical community. This rise in blood pressure can also cause stroke, heart attack, and multi-organ failure if not treated at the proper time. For example some drugs causing pulmonary fibrosis are also illegal. In worse cases, it can happen even with the first dose of the drug if the dosage is too high.

Prolonged abuse of Ecstasy and cocaine can cause oliguria, albuminuria, and decreased renal function. 50% of American adults have used these drugs sometime in their lifetime which manifest later as deteriorating renal function. This can aggravate chronic renal failure which means renal failure which progresses over a period of months and years.

Medications That Cause Kidney Stones

Kidneys are key organs in the elimination of drugs and their metabolites. So what damages kidneys? They are concentrated in the urine and passed through the bladder. Due to the intimate relationship between drug elimination and renal calculi, there are some medications that cause kidney stones. These medications can cause metabolic abnormalities that can facilitate the growth of stones.

The Medications That Cause Kidney Stones Include:

  • Loop diuretics
  • Carbonic anhydrase inhibitors
  • Topiramate
  • Zonisamide
  • Ciprofloxacin

The information to remember about the medications that cause kidney stones is that their use is generally safe and FDA-approved. If a doctor recommends these medicines, it means the benefits of these drugs on the general health of the patient outweigh the potential risks of kidney stones.

Alcohol And Kidneys

While alcohol is popular in adults and even legal in most of the countries in the world, still it is toxic to the human body. Alcohol and kidneys don’t go along. It has a strong nephrotoxic, hepatotoxic action which makes even a small amount of alcohol dangerous. Most of the alcohol metabolism is done in the liver but the excretion of the metabolites is done in the kidney through urine which is the main passage for damage to kidneys in response to alcohol consumption.

The small and occasional alcoholic drink does not pose much threat of alcohol and kidneys failure. Renal damage is a potential risk in alcoholics who are taking large amounts of alcohol for a long time.

Symptoms of Renal Dysfunction Due to Alcohol Toxicity Include:

  • Nausea
  • Fatigue
  • Disturbed sleep
  • Symptoms of acute kidney injury in worse cases
  • Altered mental level
  • Pain or blood during urination

These symptoms can be attributed to dehydration due to the hangover effect of the alcohol and kidneys and direct destruction of kidney glomeruli due to alcohol metabolites. If one suspects alcohol intoxication and a problem with their kidney functioning, they should contact a doctor immediately. Deranged renal function tests along with chronic alcohol intake can point toward renal injury. Alcohol can exasperate damage to kidneys if there is some other associated medical condition like diabetes or hypertension.

Some pills and a glass of water with a woman in pain in the background.

Overdose Kidney Failure: Is There Any Relation?

Many over-the-counter and prescription drugs can cause kidney and liver failure. Studies have reported safe drugs leading to overdose kidney failure. Intravenous drugs are at higher risk of causing renal failure as they bypass the first-pass metabolism of the liver and directly affect the kidney. They can cause nephrotoxicity with much smaller doses intravenously and parenterally than the oral route.

Common Drugs That Can Cause Overdose Kidney Failures Are:

Some of these are regularly prescribed for various ailments. They usually don’t cause renal toxicity. To put things in perspective, 20 tablets of paracetamol will be able to cause kidney and renal failure in a normal healthy adult. The threshold dosage for other medicines in the list is much lower than Acetaminophen. The main cause of death after barbiturate and TCA toxicity is secondary kidney and liver failure due to drug metabolites and severe hypotension caused by drug action. Similarly, opioids and cocaine can cause direct rhabdomyolysis and cause kidney failure when overdosed.

Other factors that affect drug overdose kidney failure are general health, age, previous medical conditions, race, and metabolic status. Every person has an individual threshold for a drug overdose. If the symptoms of renal failure are experienced by a person and overdose is suspected, arrange immediate medical help to prevent mortality.

Kidney Damage Treatment

Acute and chronic renal damage can both progress to renal failure. Acute damage to the kidney can be treated by withdrawing the risk substance. In case of drug overdose adequate rehydration, drug antidote, dialysis, and drug elimination through other methods are helpful in protecting the kidney and preventing it from progressing to irreversible renal damage. If the renal insult is not managed timely it can progress to irreversible renal failure.

Renal failure is not an end-life sentence. There is no known cure for renal failure but symptoms can be managed with the help of artificial kidney or dialysis. Many people live long enough and functionally sound while being on dialysis. Depending on the condition and damage done to the kidney, the doctor may recommend one of many types of dialysis. The commonest of which is hemodialysis also known as an artificial kidney.

The other option for renal failure is a renal transplant. It is a more suitable and long-term option but it has more complications like autoimmune reaction, graft rejection, and infection susceptibility.

Any drug abuse has the potential for renal failure. This is why it is important to take the dose recommended by doctors. In case of any deranged renal function or aforementioned symptoms consult a doctor immediately for medical attention. For substance abuse rehabilitation please contact American addiction centers. Reach out for help and get a referral to the addiction rehab facility nearby.

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Published on: January 17th, 2022

Updated on: January 17th, 2022

About Author

Juliette Siegfried, MPH

Juliette has been working in the health communications field since 1991, when she began working at the National Cancer Institute of the National Institutes of Health in Bethesda, Maryland. Her initial campaigns focused on smoking cessation and cancer prevention. Juliette later moved to the corporate side of health communications, including working at Kaiser Permanente, where she designed interactive computer-based training for health education.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.